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Thursday, March 20, 2014

Getting The Most Bang For Your Buck!

I had a
post on Client Intake a while back, where I briefly summarized how I
conduct intakes on new clients. A proper assessment and intake is necessary
when beginning to work with any client. Typically the supervisor on the case
conducts the intake, although sometimes the direct staff may be responsible for
this task.

When I am
conducting an intake, in addition to assessment, interview, record review,
going over the contract, and observation, I also like to do my own brief
version of“ABA 101”. I like to review
the program book, answer any questions, and discuss tips for getting the
most out of ABA therapy.

The parent
or family you are sitting across from during an intake initiated services for a
variety of reasons. They expect to see change. They expect to learn from you.
They expect their lives to improve. They expect to have their hopes met, and
their fears diminished. For these reasons, its important to help families
understand what they can do to get the MOST out of ABA therapy.

Just
because a family has requested ABA services does not mean they understand what
ABA can do, or what its all about. Parents might ask you things like “How long do
we have to do this?”, “Is he going to cry/tantrum every day?”, “Am I supposed
to participate or stay out of the way?”, “Should we go buy some
Skittles/M&M’s?”, “How soon until she starts talking?”, “Isn’t my child too
young/old for this?”, etc.

You may be
able to tell from the questions tossed your way the ABA knowledge level of your
new client, or you may need to do a bit digging and get them talking to know
for sure. You can also try using some ABA terms and see if the family is
familiar with them. For example, “Can you describe systems of reinforcement you
have used in the past to help with homework completion?”

There are
multiple reasons why its helpful to know if your new client is an ABA expert, novice,
or somewhere in between:

Helps with composing parent
training – I typically can gather enough information from my first few
meetings with a new client to start creating parent training documents. Through observation or interview I will learn about the issues the parents are
struggling with: Compliance, Bedtime routine, Transitions, Feeding, Toileting,
Sibling interaction, etc. Or, basic behavior concepts like Reinforcement.
Knowing the ABA knowledge base of your client will help you to
individualize your approach to parent training (which will make the
information more effective, if they can actually…..you know….understand
it).

Helps with designing behavior
plans – The behavior plan basically states how all caregivers will react
to a specific behavior, and what new behavior will be taught and
reinforced. I can write very simple behavior plans, or pretty complex
ones. Some behavior plans I hand to a staff member, and sometimes there is
no staff which means the parent gets the behavior plan. Its important as
an ABA professional to know how to modify what you come up with to fit the
audience. You WANT the family involved, so be sure you aren’t overwhelming
or frustrating them with the documents you create.

Helps with selecting best
teaching methodology – The teaching methodology used should encompass what
is best for the learner, the family’s preferences, the expertise/training
of staff, etc. Some households are better suited for DTT, while in other
households NET/Incidental Teaching may be a better choice. Also, some
parents may have negative views about certain methodologies, such as being
very against DTT. If so, a different teaching methodology can be utilized
that has more parent “buy-in”.

Paves the way for active
parent involvement – Similar to having a contract to review, explaining ABA
effectiveness strategies sends the message that you are a professional who
takes your job seriously, and it makes it very clear that you will not be
doing the “heavy lifting” alone. I like to explain this to parents by
saying that I will work hard, they will work hard, and the kiddo will work
hard…..we all have a part to play.

Provides information for your
Shaping process- Much of what ABA
professionals do with new clients involves shaping. Most of us know how to
use shaping to teach the kiddos we work with, but much of the work we do
with the family also utilizes shaping. If I have just started to work with
a parent who is new to ABA, I can’t walk in and hand her an Automatic
Stimulus Pairing procedure and
expect 100%follow through.
That’s completely unrealistic. I have to start slowly, meet the parent
where he/she is, and gradually raise my expectations over time. If I don’t
know how knowledgeable the parents are about ABA, then shaping becomes
much more difficult.

Below is
the handout I give to new clients to provide concrete strategies that will help
them get the most out of ABA therapy. I find that families who incorporate
these strategies often report the most satisfaction, or see the most gains from
therapy. The reason why is simple: ABA therapy is meant to be intensive and to
generalize across individuals and settings. The more the family is doing what I
am doing, the more effective treatment will be.